Neurologic Disorder Psychiatric

MEDICAL NUTRITION IN NEUROBEHAVIORAL

Neurologic Disorder
Medical Nutrition in

Medical Nutrition in Neurologic Disorder

The nutritional management in patient neuologic disease is complex.
Severe neurologic impairement compromise

the mecanism and cognitive abilities needed for adequat nourishment;

Dysphagia

Ability to obtain, prepare, and present food to the

mouth. All of neurologic patients are at risk for malnutrition.

Medical Nutrition in Neurologic Disorder

First step: Recognition sign and symptoms Implementation of appropriate care plan to meet nutritional requirement. Counseling for the patient and family members on dietary choice. Second: Regular evaluation of the patients nutrition status inrelation to the disease management.

Nutritional Assessment
Detail of diet history
History of weight loss or gain, weight loss 10

% or more indicated malnutrition. History of chewing, swalowing and rate of ingestion Anemias should be note, because synthesis of neurotransmiter dopamine and serotonin needed iron.

Problem with Access to Food

Chronic neurologic disease, a decline in function may hinder the ability for self-care.
Fullfiling nutritional need and malnutrition

are concern. Access of food satisfying basic needs may depend on involvement of family, friends, or professionals.

Problem with Access to Food

In acute neurologic situations:
trauma,
stroke, or Guillain-Barre syndrome,

Proccess of eating can be interrupted abruptly

Patient may need enteral nutrition support

for a period of time, until overall function improve and eating can be resume.

Meal Preparation
Dificulty with meal preparation: Confusion Dementia Impair vision Poor ambolation
Prepackaged and single servings can be encouraged.

Feeding Issues: Presentation of Food to the mouth

Hemiparesis:
Risk of aspiration Sit as upright (90 degree angle) as posible If patient must be in bed during meal time,

piloows can be used to bank and support the paretic side.

Hemianopsia:
A patient may eat only half content of meal. The patient must learn to recognise, compesated

by turning the head.

Eating: The Oral Process

Dysphagia Sawalowing;
Oral phase Pharengeal phase Esophagal phase

Liquids
Liquid can be tickened with nonfat dry milk powder, corn

starch, modular carbohydrate supplement, or commercial (contain cornstarch)

Textures
Food consitency soft Small frequent meal

Nutrition Support
Benefit to acute and chronic neurologic disorder
In acute disease it may be required initialy

until a degree of function regain. In chronic disease it may be required in the late stages to meet changing metabolic demands. Well managed nutrition support help to prevent pneumonia and sepsis.

Nutrition Support
Enteral tube feeding (enteral) may be necessary

if the risk of aspiration from oral intake is high or if patients cannot eat enought to meet their nutritional need. In later case nocturnal tube feeding can bridge the gap between oral intake and actual nutritional requirenment. In most instances the GI tarct function is intack. Exception occurs after SCI, ileus is common for 710 day after insult, this condition parenteral nutrition may be neccessary.

Nutrition Support
Nasogastric tube can be delivered as a short term

option. Percutaneus endoscopic gastrostomy (PEG) or gastrostomy-jejenoustomy (PEG/J) tube is preferred for long term nutritional management. In acutely ill, well nourished indivdualwho is unable to oral alimentation for 7 days, nutrition support in used to prevent decline in nutrition, until oral nourishement can be resumed. Conversely in the chronical ill, ussually need a prolong nutrition support. In advance stage of disease, nutrition support should enhance the quality of life of patient, health care team plays an important role in alleviating patient and family conrcern.

Neurologic Diseases Arising From Nutritional Deficiancy or Excesses

Beri-beri (def. B1) and pellagra (def. Niacin)
Pernicious Anemia (def B12) Wernicke-Korsakoff Syndrome (WKS) (def.

Thiamin). Stroke (excessed of macronutrient)

Stroke
Nutrition Management: Maintain adequate nutrition Assess and manage dysphagia Vitamin and mineral supplementation as needed. Enteral nutrition support may be necessary.

Neurologic Disease With Nonnutritional Etiologies

Adrenomyeloleukodystrophy (ALD). Azheimers disease Amyotrophic Lateral Scleroris (ALS) Epilepsy Guillain-Barre Syndrome (GBS) Migraine Headache Myastenia Gravis Multiple sclerosis Parkinsons Disease Neuro and spine trauma.

Medical Nutrisi Therapy for Psychiatric Condition

Mental Illness: Axis I Axis II

Nutritional Aspect of Brain and Nervous System Structure and Function

Omega-3 Fatty Acid: -Linolenic Acid (ALA) (18:3 n-3) Ecosapentanoic acid (EPA) (20:5 n-3) Docosahexanoic acid (DHA) (22:6 n-3)

Food sourches of ALA

Broccoli, cooced Brussel sprouts

Cabbage
Canola oil Flaxseed, ground Flaxseed oil Kale Parsley Pumkin seed Soybean oil

Food sourches of ALA

Broccoli, cooced Brussel sprouts Cabbage Canola oil Flaxseed, ground Flaxseed oil Kale Parsley Pumkin seed Soybean oil Spinach Spring green Walnuts Walnuts oil

Adequate DHA and EPA

Strategy to achieving and sustaining a healthy brain and nervous system:
During pergnancy and lactation
During infancy During adulhood

Sourches of DHA and EPA

Menhaden: include surface part and bone of fish.
Microencapsulated fish oil powder

DHA and EPA produce ed by other livestock.

Marine algae

An Integrative Approach

Nutrition Basic principles Nutritional Supplements

Omega-3 Fatty Acids Zinc Magnesium Multivitamins

Creative Behavioral Approaches

Nutrition recomendations

Goal 1 : Consumtion of DHA and EPA:

Need daily to sustain brain and nervous

system Daily recommended minimal 220 mg each of both DHA and EPA All sea food is beneficial regard to n-3 content

Goal 2 : Maintenance of a Diet with a Low Total Daily omega-6 to Omega-3 Ratio
War of saturated fat, increase intake of

omega-6 (n-6) fatty acids. A high n-6:n-3 ratio (>10) appears to promote implamation and oxidation. (American diet this ratio 17:1) A beneficial n-6:n-3 ratio close to 2:1. In very low fat diet (vegetarian) can have high n-6:n-3 ratios.

Goal 3: Avoidance of Restriction Diets that Encourage Rapid Weight Loss

Restriction energy intake cannot specify with

type of fat. Restriction diet create n-3 fatty acid acid are being liberated and oxidized. Supplementation n-3 ALA during weight loss not preserve n-3 store in tissues. Restrictive eating creating DHA deficiency has been shown to affect brain function.

Goal 4: Increased Antioxidant Intake

The two major goals to maintenance of healthy fatty acid levels are :
increase the level through dietary choices (n-3 fatty acid)

and To prevent their oxidation through dietary food choices (antrioxidant).

Although DHA is an antioxidant, antioxidant in other food importance in preserving these fat as well. A diet rich in fruit and vegetable is an important strategy, contain vitamin, mineral and antioxidant.

Antioxidant Activity in the Brain and Nervous System

-lipoic acid Anthocyanins Curcumin EPA Gingko biloba Gluthatione Grapeseed Green tea Manganese Manitol Miso Quercetin Resveratrol Selenium Thiamin Vitamin A Vitamin B12 Vitamin C Vitamin E Zinc